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Physician Supervisor, Utilization Management

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CVS Health

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Location:
United States , Work at Home

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Category:
-

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Contract Type:
Employment contract

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Salary:

174070.00 - 374920.00 USD / Year
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Job Description:

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Physician Supervisor, Utilization Management is responsible for overseeing the day to day utilization management (UM) processes to ensure the delivery of high-quality, cost-effective healthcare services. This role involves managing the review of medical necessity, appropriateness of care, and the coordination of healthcare services. The Physician Supervisor will lead and manage a team of UM physicians, providing guidance, support, and professional development opportunities to optimize team performance.

Job Responsibility:

  • Lead and manage the Utilization Management team, providing guidance, training, and support to the day to day issues
  • Support recruiting, hiring, and retaining skilled UM clinical staff, fostering a collaborative and high-performance work environment alongside Manager, Utilization Management
  • Conduct regular performance evaluations, offering feedback, coaching, and professional development opportunities
  • Monitor and evaluate the performance of the UM team, ensuring efficiency and effectiveness in all UM activities
  • Conduct and oversee clinical reviews of medical records to determine the medical necessity and appropriateness of healthcare services
  • Ensure timely and accurate review of prior authorizations, concurrent reviews, and retrospective reviews
  • Collaborate with healthcare providers to facilitate appropriate utilization of healthcare resources
  • Ensure compliance with all federal, state, and local regulations related to utilization management
  • Stay current with changes in healthcare regulations and standards affecting UM practices
  • Work closely with other departments, including Transitions, Case Management, and Care Teams, to ensure coordinated and integrated care
  • Serve as a clinical resource and advisor to the UM team and other departments
  • Other duties as assigned.

Requirements:

  • At least 2 years experience providing Utilization Management services to a Medicare and/or Medicaid line of business
  • Excellent verbal and written communication skills
  • A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)
  • Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
  • 3-5 years of clinical practice in a primary care setting
  • Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
  • Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
  • Demonstrated understanding of culturally responsive care
  • Proven organizational and detail-orientation skills
  • Ability to collaborate effectively with a staff, providers, and a diverse group of leaders
  • US work authorization
  • Someone who embodies being Oaky

Nice to have:

Prior clinical leadership or supervision experience is preferred.

What we offer:
  • Mission-focused career impacting change and measurably improving health outcomes for medicare patients
  • Paid vacation, sick time, and investment/retirement 401K match options
  • Health insurance, vision, and dental benefits
  • Opportunities for leadership development and continuing education stipends
  • New centers and flexible work environments
  • Opportunities for high levels of responsibility and rapid advancement
  • Medical, dental, and vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 11, 2027

Employment Type:
Fulltime
Work Type:
Remote work
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